<div id="content-container" class="container">
    <div class="user-section login-section">
        <div class="logon-tab clearfix"> <a href="{:url('user/login')}">{:__('Sign in')}</a> <a class="active">查询</a> </div>
        <div class="login-main"> 
            <form name="form1" id="register-form" class="form-vertical" method="POST" action="">
                <input type="hidden" name="invite_user_id" value="0" /> 
                {:token()}
                <div class="form-group">
                    <label class="control-label required">大保单号<span class="text-success"></span></label>
                    <div class="controls">
                          <select id="big_number" name="big_number"    class="form-control selectpicker"  style="height:3.5em">
                                    <option value="11077003900529071292" data='1'>11077003900529071292</option> 
                                    <option value="11077003900613414447" data='3'>11077003900613414447</option>
                                    <option value="PZAH201942010000000095" data='3'>PZAH201942010000000095</option>
                                    <option value="PZAH202042010000000011" data='3'>PZAH202042010000000011</option>
                                    <option value="PZAH202042010000000010" data='3'>PZAH202042010000000010</option> 
                            </select> 
                        <p class="help-block"></p>
                    </div>
                </div>
                <div class="form-group">
                    <label class="control-label">子保单号</label>
                    <div class="controls">
                        <input type="text" id="small_number" name="small_number"  class="form-control input-lg" placeholder="请输入子保单号">
                        <p class="help-block"></p>
                    </div>
                </div>
                <div class="form-group">
                    <label class="control-label">手机号</label>
                    <div class="controls">
                        <input type="text" id="tel" name="tel"  class="form-control input-lg" placeholder="请输入手机号">
                        <p class="help-block"></p>
                    </div>
                </div>

            <!--     <div class="form-group">
                    <label class="control-label">姓名</label>
                    <div class="controls">
                        <input type="text" id="real_name" name="real_name"  class="form-control input-lg" placeholder="请输入姓名">
                        <p class="help-block"></p>
                    </div>
                </div>
                <div class="form-group">
                    <label class="control-label">证件号</label>
                    <div class="controls">
                        <input type="text" id="card_no" name="card_no"  class="form-control input-lg" placeholder="请输入证件号">
                        <p class="help-block"></p>
                    </div>
                </div>  -->

                <div class="form-group">
                    <button type="submit" class="btn btn-primary btn-lg btn-block">查询</button>
                </div>
            </form>
        </div>
    </div>
</div>